Severe hypophosphatemia induced after first cycle of the ESHAP protocol for Hodgkin's lymphoma: a case report

Abstract

The effect of the ESHAP (etoposide, methylprednisolone, cytarabine, cisplatin) salvage protocol on serum electrolytes has been previously reported by individual observational studies. The most commonly described electrolyte affected by the ESHAP protocol is magnesium. In addition, hypophosphatemia has been studied and reported as a complication of cisplatin therapy, although it is usually asymptomatic. This is a case report of a 51-year-old woman with relapsed Hodgkin’s lymphoma who developed severe hypophosphatemia following administration of the first cycle of the ESHAP protocol. The patient started to develop gradually decreasing phosphate levels 2 weeks after receiving chemotherapy, which needed to be corrected by phosphate supplementation. This case report raises concern regarding hypophosphatemia as a possible side effect of the ESHAP protocol and points to a need for close monitoring, taking into consideration vitamin D levels, urinary phosphate excretion, parathyroid hormone levels, and arterial blood gas analysis to rule out other contributing factors. Health care providers should be made aware of this possible toxicity. Critical monitoring of phosphate levels and considering supplementation is warranted with the ESHAP protocol, especially when it is used in combination with granulocyte colony-stimulating factor and diuretics, to prevent such possible hypophosphatemia. Further investigations may be required to confirm and evaluate the significance of this type of toxicity.

Assessment of nephrotoxicity associated with combined cisplatin and mitomycin C usage in laparoscopic hyperthermic intraperitoneal chemotherapy

“…Another important finding of our work is the high incidence of hypophosphatemia and hypocalcemia observed postoperatively. Although hypocalcemia has been associated with the nephrotoxicity seen with systemic and intraperitoneal chemotherapy using cisplatin, hypophosphatemia is not a typical finding seen with its use, with only one case report linking the two [26]. Considering that these electrolyte abnormalities were not evident on preoperative laboratory assessments, an association could be made between the postoperative values and some aspect about the procedure itself.…”

Reply to letter: Nephrotoxic synergism of cisplatin and mitomycin-C for hyperthermic intraperitoneal chemotherapy and cytoreductive surgery by Kapoor R, Robinson K and Badgwell B

“…We agree that in addition to the type, dose and duration of exposure to the chemotherapeutic agent, the use of multiple agents in HIPEC will likely have a significant impact on complications. The systemic and intraperitoneal administration of cisplatin has been associated with hypocalcaemia owing to its nephrotoxic effects [1,2], but we could only find one case report linking it with hypophosphatemia [3].…”